Please help

Mhairi said:

We bribed him with chocolate in the end, but I realise that would not work in your circumstances with an older child.

I wouldn't be so sure about that!

It's a generalisation, of course, but we, on the spectrum, are often motivated more by reward than by punishment.

I know if you want me to do something you're much more likely to succeed by offering me some kind of tangible reward for doing it, than by berating me for not doing it.

So something like a start chart might well work, with the child getting a star for each day they manage to stay clean (though, it's then important to make the child feel like they're not being punished on days when they don't), then at the end of the week they get a reward based on how many stars they have - I would think it would work best if you have several things that the child can get stars for - so that even on bad days there's likely to be something positive to give a star for.

I do not know anything about this area however, I can see that there may be sensory issues at play and the other random thought I had was an Osteopath.  My son has High Functioning Autism and ADHD and is 10.  We tried 3 Osteopath sessions as recommended to us by someone that had heard it can help.

My son is wary and nervous around strangers and new situations.  Amazingly he was lying on the table with the Osteopath handle his head, shoulders, rib cage area etc.  He enjoyed the 20/30 minute sessions and was definetely more relaxed.  He asked me if my son had any constipation type difficulties or with toilieting.  They work a lot on relaxing the central core area around the diaphragm as this connects up to the spine/neck/head etc.  or something like that.  May be worth looking into at least.  Our 3 sessions certainly helped him relax physically and he stopped complaining of stomach aches.

On the sensory my son was 3.5 before he stopped soiling and although he knew well before then when he needed to go, he would hide or deliberately do it in his pants rather than the toilet.  We thought it was because he was afraid of the sensation and of the sensation when on the toilet.  We bribed him with chocolate in the end, but I realise that would not work in your circumstances with an older child.

Best wishes

I really cannot understand why they want to admit him to clean him out if he's not actually blocked up that's odd and I think you should get some clear answers from the docs as to why they feel he needs that done. If he's going regularly then I don't think he should really be on movicol (or is it a v.low dose?) or senna because that could actually be causing the soiling if it's stimulating his bowels / making the stools softer he may be leaking and not know until it's too late. My daughter only gets blocked up every now and again like I said and her paediatric urologist (she has kidney problems) suggested 1 sachet a day to keep her regular but less if she manages to go regularly on her own.

I'm baffled really, if he's not aware of the soiling until it's already happened (so he's not doing it on purpose) but the docs are saying it's not medical then I'm stumped really, I hope you get some answers soon.

Have you asked him why he gets violent? Not just why did you hit/kick/whatever X person? But specifically what happened in the hour or so leading up to him attacking someone.

Thanks for you comment :)

Yes my son has been seen by pediatricians and the Gastro team , he has had xrays and Blood tests and his stomach is always soft . Our consultant said that it is not medical , they are giving him the Movicol and Senna to try and see if he will ' feel ' anything ?? Our new pediatrician thinks his soiling may be down to Autism , he also has many other signs of Autism .

He was constipated like your daughter at the age of 4 and passed a large stool and since then he soils , we have tried every toileting tequine going .

We have asked him many times why he does it but like us he does not know . Even when he soils he is not aware of it . He gets told in school to ' clean himself up ' but he does not do it , so when he comes home he is sore :(

Since December the violence in school is becoming so much worse , he is having 1-2 major incidents a week ( head butting , kicking , biting other children )

Both me and my Husband feel like the school cannot cope with him anymore , he is not allowed any playtime or allowed to go outside after lunch , he has to sit inside and read a book which is making him more difficult .

Thanks for your support , it is very much appreciated :)

Hi Jen :)

I have a 6yr old who sometimes soils herself but it is related to a chronic bowel condition. Basically she became constipated at one point when she was 3, passed a largish hard stool and then she was afraid to go which meant she held on and ended up with overflow incontinence. It took us over a year with lots of help from a paediatric team to get her going regularly but she still has a problem with it now(she's nearly 7). What happens is she forgets to go, she doesn't like the interruption bathroom breaks cause so she will wait until the last second to go, with her bladder she can only do that for so long but she can stop her poo for days. So she ends up getting constipated and then worries about passing it and we end up increasing her movicol dosage(she's on a satchet a day) to clear her out. She gets over it and she will be regular for months and then randomly she will hold on again.

Have you asked your son why he soils himself? With my daughter she is completely unaware that she has soiled herself (due to the overflow incontinence) until she changes her underwear or goes to the toilet and sees it's dirty. If your son is aware of doing it ask him why he thinks he's doing it, does he enjoy the feeling of it or perhaps he likes the routine of it (soiling, cleaning up, changing underwear etc and repeat). 

Have the docs actually checked whether he is blocked up? My daughter had a couple of x-rays done during her time under paediatric care to see just how badly blocked up she was. What medication have they tried him on? Usually they prescribe movicol but my daugter ended up on sodium picosulphate because she was so bad and that was very good that cleared her out no problem. I don't see why they want to admit him if he's not got fecal impaction(sp?). How often is he passing stools? Plus there are usually other signs when the bowel is badly impacted. With my daughter when she was really bad she would hardly eat, she soiled herself at least every hour, she would sometimes wet herself because the stool would be putting pressure on her bladder as well. Her moods were terrible too because she felt so unwell from being so blocked up, plus sometimes you could feel it if you pressed on her abdomen.

thank you so much for your comment ,

He will sit on the toilet but has not got the concentration to sit for long , we have tried everything , he will pass a stool but then when off the toilet will soil himself within 10 minutes .

I have googled it and is related to Autism , I am really worried because they want to admit him into hospital to be ' Cleaned out ' but the thing is he cannot handle any change at all and me and my Husband think that it will make his mental state worse .

Also we have been told by a top Gastro consultant that it will not improve his condition :( , I am so worried , all I am doing is crying .

Thanks again for your comment .

Yes, I believe soiling oneself can be a problem associated with autism.

This, as I understand it, is often because of a hypo-sensitivity to ones internal sensations, such as the need to go to the toilet.

However the automated physical responses, that one normaly learns to override, still function perfectly.

Unfortunately I've no idea how one might go about stopping it from happening.

i have never read anything about soiling oneself as being an autistic thing. i dont even recall seeing it as a common symptom of any comorbid illnesses. but i'm not an expert.

does your son use the toilet at home at all? or is it just when in public? the reason i ask, is when i was in preschool, i was too afraid to ask one of the preschool workers to take me to the toilet.

if all the physical workings are fine, then looking at cognitive causes is definitly a logical step.

have you googled any of this at all?